Factors related to nursing burnout: a review of empirical knowledge

Agile Delphi methodology: A case study on how technology impacts burnout syndrome in the post-pandemic era

Introduction

In the post-pandemic era, many habits in different areas of our lives have changed. The exponential growth in the use of technology to perform work activities is one of them. At the same time, there has been a marked increase in burnout syndrome. Is this a coincidence? Could they be two interconnected developments? What if they were? Can we use technology to mitigate this syndrome? This article presents the agile Delphi methodology (MAD), an evolved version of the Delphi method, adapted to the needs of modern-day society.

Methods

To drive Occupational Health and Safety (OHS) experts to reach a consensus on what technological and non-technological factors could be causing the burnout syndrome experienced by workers in the post-pandemic era, MAD has been used in a specific case study. This study formally presents MAD and describes the stages enacted to run Delphi experiments agilely.

Results

MAD is more efficient than the traditional Delphi methodology, reducing the time taken to reach a consensus and increasing the quality of the resulting products.

Discussion

OHS experts identified factors that affect and cause an increase in burnout syndrome as well as mechanisms to mitigate their effects. The next step is to evaluate whether, as the experts predict, burnout syndrome decreases with the mechanisms identified in this case study.

Occupational safety perceptions of prehospital emergency health services employees: A sample of Sivas central district

BACKGROUND

Prehospital emergency health services ambulance workers are in the risky class in terms of occupational health and safety, and they are faced with more risks due to the fact that they are the first responders to the events, especially regarding COVID-19.

OBJECTIVE

The aim of the present study is to determine the occupational risk perceptions of health care workers and their relations with demographic variables.

METHODS

A literature review was performed to develop a questionnaire. This questionnaire was used in a survey with 250 respondents. The collected data was analysed through factor analysis. Cronbach's Alpha was calculated to verify the reliability of the data.

RESULTS

The risk perceptions of the employees (Factor 1 and Factor 3) differ significantly according to gender. Another important point is that 60.3% of the participants stated that they "agree" with the statement that health workers "experience violence" during work.

CONCLUSION

The risk perception of women was found to be higher, and the reason for this is that women are less physically strong than men along with social gender roles and gender discrimination.

Assessment of job satisfaction, lifestyle behaviors, and occupational burnout symptoms during the COVID-19 pandemic among radiologic technologists in Saudi Arabia

INTRODUCTION

Radiologic technologists (RTs) are among the healthcare staff negatively impacted by job dissatisfaction, occupational stress, and unhealthy lifestyle behaviors, especially during the COVID-19 pandemic. The aim of this study was to assess job satisfaction, lifestyle behaviors, occupational burnout symptoms, and associated factors among RTs in Saudi Arabia.

METHODS

A survey study was conducted from January 2021 to February 2022 using a self-administered questionnaire. The questionnaire gathered socio-demographic information, answers to the Minnesota Satisfaction Questionnaire, lifestyle behaviors, and frequency of occupational burnout symptoms. Data were analyzed to obtain descriptive and inferential statistics.

RESULTS

A total of 261 RTs completed the survey. Participants were predominantly male and most were working in public hospitals. The overall mean score for job satisfaction was 3.77 (of 5), indicating moderate job satisfaction, with two items showing low satisfaction- compensation (3.33) and advancement (3.28). The overall mean score for lifestyle behaviors was 2.00 (of 3), indicating moderate lifestyle behaviors, with the lowest scores reported in sleep quality (1.92), healthy diet (1.85), and relaxing and unwinding (1.86). For burnout symptoms, the overall mean score was 2.30, indicating moderate burnout level, with the highest score reported in experiencing physical symptoms (2.72). There were significant relationships between job satisfaction, lifestyle behaviors and burnout symptoms. A positive and moderate relationship, r = 0.53 (p < 0.05), was found between job satisfaction and healthy lifestyle behaviors. The burnout relationships with job satisfaction, r = -0.615 (p < 0.05), and healthy lifestyle behaviors, r = -0.524 (p < 0.05), were negative and moderate relationships CONCLUSION: The interrelationships between job satisfaction, lifestyle behaviors, and occupational burnout symptoms suggest that improving lifestyle behaviors and managing burnout symptoms could contribute to higher job satisfaction.

IMPLICATIONS FOR PRACTICE

Policymakers should focus their efforts in the workplace health promotion programs to play essential roles in promoting healthy lifestyle behaviors and occupational stress management, as well as, improvements of RTs career advancement and compensation.

A Cross-Sectional Study of Job Satisfaction and Intention to Leave Job in Palliative Care in Croatia

Purpose Stressful and demanding clinical situations may contribute to job dissatisfaction and may even contribute to an intention to leave the job among palliative care (PC) clinicians. Personal and organizational factors may influence the occupational well-being of PC clinicians as well. This study aimed to determine the predictive contribution of personal (communication skills, resilience, religiosity) and organizational (coworkers' social support, job control) factors in the explanation of PC clinicians job (dis)satisfaction and their intention to leave their job. Methods The study was conducted on a convenience sample of 122 PC clinicians of different disciplines (nurses/technicians, physicians, psychologists, spiritual counsellors/priests, social workers, physical therapists, etc). The sample mainly consisted of nurses (57%). Hierarchical and logistic regression analyses of the results obtained were applied. Results This study indicates that 53% of PC clinicians are satisfied with their daily job and 76% do not intend to leave the job. The results showed no differences in job satisfaction and intention to leave between nurses/technicians and other PC clinicians. A significant negative correlation was found between job satisfaction and intention to leave the job. Communication skills, religiosity and coworkers' social support, showed as significant predictors of job satisfaction. PC clinicians' perception of their own difficulties in communicating bad news contributed significantly to job satisfaction and intention to leave the job in palliative care. Conclusion This study suggests that job satisfaction in a palliative care setting is determined by a larger number of personal and organizational factors than the intention to leave the job. Communication skills showed indispensable for providing quality care for dying patients. Skills in communicating bad news to dying patients and their families have emerged as particularly important for PC clinicians' occupational well-being.

Burnout in Mental Health Care Professionals Working with Inpatients in Open or Closed Wards in Psychiatric Hospitals

Mental health care professionals are at risk of experiencing burnout. This cross-sectional study aims to investigate burnout in two settings: open and closed psychiatric wards, and two professions: registered nurses and social healthcare assistants in eight psychiatric wards in Denmark. A total of 114 professionals completed the Copenhagen Burnout Inventory and a demographic questionnaire. No statistically differences in burnout in professionals working in closed and open wards were found. However, we found professionals to score highest on personal and work-related burnout and lowest on client-related burnout. This indicates that patients may only play a minor role in burnout in health professionals.

Care Managers and Role Ambiguity: The Challenges of Supporting the Mental Health Needs of Patients with Chronic Conditions

As U.S. healthcare organizations transition to value-based healthcare, they are increasingly focusing on supporting patients who have difficulties managing chronic care, including mental health, through the growing role of care managers (CMs). CMs communicate with patients, provide access to resources, and coach them toward healthy behaviors. CMs also coordinate patient-related issues internally with healthcare practitioners and externally with community organizations and insurance providers. While there have been many interaction design studies regarding the work of clinical and non-clinical healthcare providers and how best to design support systems for them, we know little about the work of CMs. In this study, we examine the role of CMs, particularly focusing on their work to support patient mental health, through interviews with 11 CMs who are part of a large Midwestern U.S. health system. Workflow observations were conducted to supplement the interview data. We describe the role of CMs and identify challenges that they face in supporting patient mental health. A key challenge is a high degree of role ambiguity in this professional role. We discuss sociotechnical implications to better support care delivery processes and technologies for the delivery of mental health services by CMs.

The Impact of Emotional Exhaustion on Psychological Factors in Workers with Secondary Traumatic Experiences: A Multi-Group Path Analysis

OBJECTIVE

The objective of the present study was to explore causal pathways to understand how second traumatic experiences could affect the development of emotional exhaustion and psychiatric problems.

METHODS

A total of 582 workers who had jobs vulnerable to secondary traumatic experiences were enrolled for this study. Emotional exhaustion, secondary trauma, resilience, perceived stress, depression, anxiety, and sleep problems were evaluated. A model with pathways from secondary traumatic experience score to depression and anxiety was proposed. The participants were divided into three groups according to the resilience: the low, middle and high resilience group.

RESULTS

Resilience was a meaningful moderator between secondary traumatic experiences and psychiatric problems. In the path model, the secondary trauma and perceived stress directly and indirectly predicted perceived stress, emotional exhaustion, depression, anxiety, and sleep problems in all three groups. Direct effects of perceived stress on depression and anxiety were the largest in the low resilience group. However, direct effects of secondary trauma on perceived stress and emotional exhaustion were the largest in the high resilience group.

CONCLUSION

Understanding the needs of focusing for distinct psychological factors offers a valuable direction for the development of intervention programs to prevent emotional exhaustion among workers with secondary traumatic experiences.

[Defining and understanding the burn out of gerontological caregivers]

The malaise in the gerontology sector can be accounted for and new explanations for caregiver burnout can be proposed. Through a review of the literature, an overview of the issue can be drawn up and a theoretical and clinical reflection can be initiated. After having contextualized the extent of the phenomenon, we will present the plural conceptions of burn out and its origin. A new look will be taken at this syndrome by raising a set of factors potentially involved in the exhaustion of caregivers.

"We try our best to offer them the little that we can" coping strategies of Ghanaian community psychiatric nurses: a qualitative descriptive study

Introduction

Community psychiatric nurses work in extremely stressful environments with intense patient relationships as they try to prevent self-harm and manage aggressive behaviors. In order to improve their ability to manage the stressful work environments, community psychiatric nurses need to incorporate formal coping strategies into their daily work routines. With evidence-based coping strategies, community psychiatric nurses can effectively manage the stressful situations in their work environment to increase their work longevity. The purpose of this study was to explore the individual coping strategies currently used by community psychiatric nurses in practice in order to develop an intervention strategy for future implementation.

Methods

This was an exploratory qualitative study using an interpretative approach. A purposive sampling method was used to identify participants from the community psychiatric nurses in a region of Ghana. Participants were recruited and interviewed, guided by semi-structured questions, until saturation was reached. The interviews were audio-taped, transcribed verbatim, and analyzed thematically.

Results

A total of 13 participants, 10 women and 3 men ages 26 to 60 years, were interviewed for this study. From the inductive analysis, four coping themes emerged from the data including: 1) self-disguise, 2) reliance on religious faith, 3) self-motivation, and 4) reduction in the number of home visits. The participants described their work environment as stressful, almost to the point of overwhelming. In this regard, they identified the individual coping strategies as critical daily practices for self care to manage their high stress levels.

Conclusion

Individual coping strategies are often used by community psychiatric nurses in daily practice. The participants identified personal coping strategies as critical interventions to manage stress and to decrease their risk for burnout. However, community psychiatric nurses must develop.personal-mastery in various coping strategies to care for themselves, as well as motivate them despite the challenging working environment. The individual coping strategies adopted by community psychiatric nurses was not only helped them deliver care, but also protected their clients so people would not label them as 'mental patients.' Collectively, the four strategies reported in this study need to be developed into a cohesive and comprehensive intervention.

Detriments of a Self-Sacrificing Nursing Culture on Recruitment and Retention: A Qualitative Descriptive Study

AIM

To investigate the presence and impact of self-sacrifice within the nursing profession.

BACKGROUND

Evidence suggests the existence of a culture of self-sacrifice within nursing, but its potential detriments to the profession have not been explored.

DESIGN

A qualitative descriptive approach was used.

METHODS

Semistructured interviews were conducted with 10 practicing nurses to explore the existence and potential implications of a self-sacrificing culture within nursing.

RESULTS

All participants reported self-sacrifice within the nursing profession as the result of the prevailing stereotypical image of the "ideal nurse," leading to job dissatisfaction, presenteeism, and burnout. Younger nurses reported being less willing to self-sacrifice and consequently felt unsupported by management and senior staff, resulting in job dissatisfaction and intent to leave their job.

CONCLUSION

A culture of self-sacrifice within the nursing profession may lead to job dissatisfaction, presenteeism, burnout, and retention problems, especially for younger nurses. A self-sacrificing image of nursing may also deter potential recruits from exploring a career in the profession.

Changes in Chinese nurses' mental health during 1998-2016: A cross-temporal meta-analysis

In China, nursing is a profession with considerable stress, which may cause both physiological and psychological problems. The present study conducted a cross-temporal meta-analysis of 244 papers using the Symptom Checklist 90 (SCL-90) to investigate the changes in the mental health level of Chinese nurses (N = 71,286) from 1998 to 2016. Results showed that (a) relationships between scores of all nine types of mental problems in the SCL-90 and year were significantly positive, indicating that the mental health level of nurses decreased steadily in the past 19 years; (b) relationships between three social indicators (patient-to-nurse ratio, unemployment rate, and divorce rate) and scores of all nine types of mental problems in the SCL-90 were significantly positive, suggesting that the increase in these social indicators may be responsible for the decrease in Chinese nurses' mental health level.

Burnout among school teachers: quantitative and qualitative results from a follow-up study in southern Sweden

Background

Teachers are at high risk of stress-related disorders. This longitudinal study aimed to (a) identify which occupational, sociodemographic and life-style factors and self-efficacy at baseline that were of importance for burnout, (b) explore associations between changes in the studied factors versus changes in burnout, and (c) by interviews increase the understanding of perceived job demands among teachers.

Methods

A cohort of 310 Swedish teachers in school-years 4–9 responded to a questionnaire of occupational, sociodemographic and life-style factors, self-efficacy and burnout, at baseline and at follow-up (mean 30 months later). A combined measure with four levels of burnout was crafted, based on exhaustion, cynicism and professional efficacy (Maslach Burnout Inventory-General Survey). Quantitative data were analysed with multiple ordinal regression, and qualitative data were analysed with content analysis of interview responses from a subgroup of the teachers (n = 81).

Results

The occurrence of high burnout (level 2 and 3 combined) were similar at baseline and follow-up (14% vs. 15%). However, many teachers fluctuated between the levels of burnout (28% increased and 24% decreased). Burnout at baseline was of importance for change of work or being off duty at follow up. In the multi-exposure model, low self-efficacy [OR 0.42; CI 0.26–0.68] and high job demands [OR 1.97; CI 1.02–3.8] were the strongest explanatory variables. Low self-efficacy remained as the strongest explanatory factor after adjustment for burnout at baseline. Increased job demands during follow-up was associated with an increased level of burnout [OR 3.41; CI 1.73–6.69], whereas increased decision latitude was associated with a decreased level of burnout [OR 0.51; CI 0.30–0.87]. Two major categories of demands emerged in the qualitative analysis; i.e. too high workload and a sense of inadequacy.

Conclusions

A substantial proportion of teachers showed signs of burnout at both occasions. Low self-efficacy and high job demands was of importance for burnout, and changes in burnout was further associated with changes in decision latitude. The results points to the need of actions on individual, organizational and a societal levels.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6972-1) contains supplementary material, which is available to authorized users.

Workplace violence and development of burnout symptoms: a prospective cohort study on 1823 social educators

PURPOSE

Burnout and workplace violence (WPV) have been associated in cross-sectional studies, but longitudinal studies with solid methods and adequate sample sizes are lacking. This study investigates whether WPV increases burnout symptoms during a 12-month period.

METHODS

Questionnaire data were collected on 1823 social educators at baseline and 12-month follow-up, coupled with additionally 12 monthly text-message surveys on exposure to WPV. Using general linear modelling for repeated measures, we estimated change over time in burnout symptoms in three WPV exposure groups (none, low, high).

RESULTS

A time by exposure to WPV interaction existed for development of burnout; F(2) = 7.2, p = 0.001 η² = 0.011. Burnout increased significantly within the group of low exposure; F(1) = 6.8, p = 0.01 and high exposure; F(1) = 6.7 p = 0.001, but not within the non-exposed F(1) = 2.1 p = 0.15. At follow-up, both the low exposed and high exposed had significantly higher levels of burnout compared to the non-exposed.

CONCLUSION

Exposure to WPV increases level of burnout within a 12-month period. We propose that assessment of burnout in future studies should utilize instruments capable of detecting small changes. We further propose that prevention against employee burnout could be improved using monitoring targeted at employees exposed to WPV.

The Social Determinants of Nursing Retention in a Pediatric Hematology/Oncology Unit

Pediatric hematology/oncology units (PHOUs) are highly paced, stressful environments and can be difficult areas to work. Thus, these units can present issues when it comes to both recruiting and retaining health care professionals (HCPs). There is scant research addressing how the environment of a PHOU contribute to a HCP's desire to stay or leave this environment. To conduct this project, a critical ethnographic approach was used. The researcher conducted semistructured interviews ( n = 29), which included nurses ( n = 21), physicians ( n = 4), and allied health care staff ( n = 4). This sample represented approximately one third of staff in each category. Participants identified that their ability to develop long-term relationships with children and families as a significant source of satisfaction. Belonging to the oncology team was seen as extraordinarily important to all the participants. The majority of the participants also felt that working in this ever-evolving dynamic medical field afforded them with ongoing learning opportunities. The main frustration described by participants pertained to administrative involvement in the everyday workings of the PHOU, potentially leading to attrition. It is important to note that there was also diversity among and between the categories of HCPs when describing the work environment and the issues that most influence them. While similarities among participants were found between satisfaction and dissatisfaction, significant differences between them led us to believe it would be unreasonable to attempt to compare the three groups here. Thus, in this article the author focused primarily on nursing while noting related observations from physicians and allied health professions.

Factors Associated with Emotional Exhaustion in South Korean Nurses: A Cross-Sectional Study

OBJECTIVE

We examined associations between emotional exhaustion and selected sociodemographic and psychological factors among nurses in inpatient and outpatient nursing units at a university hospital in South Korea.

METHODS

The participants were 386 nurses who completed the Maslach Burnout Inventory, a measure of emotional exhaustion. Psychological characteristics were evaluated, including hardiness, self-esteem, experience of trauma, resilience, perceived stress, and social support. Correlation analyses examined the relationships between emotional exhaustion with sociodemographic, occupational, and psychological characteristics. Linear regression was used to evaluate the associations between emotional exhaustion and the assessed characteristics.

RESULTS

Higher emotional exhaustion scores were associated with greater depression, anxiety, traumatic experience, and perceived stress. Exhaustion was inversely associated with hardiness, self-esteem, resilience, and quality of life. The regression analysis indicated that gender, marriage, resilience, depression, perceived stress, and secondary traumatic stress were significantly associated with emotional exhaustion.

CONCLUSION

This study showed that psychological characteristics, such as resilience, depression, and secondary traumatic experiences, may cause emotional exhaustion. Understanding the needs of people with distinct demographic and psychological characteristics offers valuable direction for the development of intervention programs to prevent burnout among nurses.

Defense Styles Mediate the Association Between Empathy and Burnout Among Nurses

Research has extensively identified empathic skills as essential in health trainings, policies, and recommendations. However, there have been conflicting views of the impact of empathy on burnout. Some studies contend that empathy serves a protective role, whereas other studies have shown that burnout leads to a diminished capacity to empathize. To date, studies have not yet explored whether defense styles mediate associations between empathy and burnout. A total of 442 nurses completed questionnaire measures of empathy, burnout, and defense mechanisms as part of a large-scale research study on nurse burnout. Findings reflected very high levels of emotional exhaustion and depersonalization among the nursing staff. The nurses in this study endorsed a predominantly immature defense style. In addition, immature defense styles mediated the association between empathy and emotional exhaustion and between empathy and depersonalization. The study provides further knowledge about the role of defense styles in nurse burnout and empathy.

Burnout Evaluation and Potential Predictors in a Greek Cohort of Mental Health Nurses

BACKGROUND

Job burnout is one of the most serious occupational health hazards, especially, among mental health nurses. It has been attributed among others to staff shortages, health service changes, poor morale and insufficient employee participation in decision-making.

AIM

The aim of this study was to measure burnout among mental health nurses, investigate relations between burnout and organizational factors and examine potential predictors of nurses' burnout. Specifically, this study aimed to investigate whether role conflict, role ambiguity, organizational commitment and subsequent job satisfaction could predict each of the three dimensions of burnout.

DESIGN/METHODOLOGY/APPROACH

During current cross sectional, the survey was administered to 232 mental health nurses, employed in four private psychiatric clinics in the region of Larissa, Thessaly, Greece in May 2015. Our findings were based on the responses to 78 usable questionnaires. Different statistical analyses, such as correlation analyses, regression analyses and analyses of variance were performed in order to explore possible relations.

FINDINGS

High emotional exhaustion (EE) accounted for 53.8% of the sample, while high depersonalization (DP) and high personal accomplishment (PA) accounted for 24.4% and 25.6%, respectively. The best predictors of burnout were found to be role conflict, satisfaction with workload, satisfaction with training, role ambiguity, satisfaction with pay and presence of serious family issues.

PRACTICAL IMPLICATIONS

These findings have implications for organizational and individual interventions, indicating that mental health nurses' burnout could be reduced, or even prevented by team building strategies, training, application of operation management, clear instructions and psychological support.

Stress, Fatigue, and Workload in Intensive Care Nursing: A Scoping Literature Review

Stress and fatigue are being interchangeably used in the nursing literature resulting in operationalization and measurement issues. A scoping review was conducted to identify different definitions and operationalization of these constructs. Findings can be used to develop tools to measure stress and fatigue as different constructs to aid nursing administrators to gain a new perspective into nursing schedule, workload, morale and well-being of nurses. The findings show that there is a research gap in measurement of acute stress in nursing, physiological measures are currently not used for continuous assessment of stress or fatigue for nurses, and lack of stress and fatigue definitions in terms of physiological measures for assessment purposes. Continuous monitoring and physiological measures such as heart rate can be used to measure and differentiate between the constructs of stress and fatigue

Explaining attrition and decreased effectiveness of experienced teachers: A research synthesis

BACKGROUND

Teacher retention and development of the full potential of teachers is important at a national level in order to be able to belong to the top world economies. A number of studies suggests that part of the group of experienced teachers with more than 20 years of experience perform didactically at a lower level than would be expected and are at a greater risk for attrition.

OBJECTIVE

The aim of the present study is to find explanations for this by making use of the Job Demands Resources Model.

METHODS

Specific demands of the teaching profession, interpersonal demands related to the developmental stage of experienced teachers, job resources and personal resources in relation to health and motivation are explored by reviewing a vast amount of literature.

RESULTS

The proposed conceptual model is an extension of the Job Demands Resources Model with the inclusion of personal demands related to adulthood and personal resources.

CONCLUSIONS

The resulting model provides us with clues on how attrition and decreased performance could be counteracted.

The role of emotional intelligence and organisational support on work stress of nurses in Ibadan, Nigeria

Background

Universally, nurses have been reported to be a group at high risk of workplace stress. However, nurses’ responses to stressful situations at work could be the outcomes of individual differences and organisational factors.

Objectives

We examined the independent and joint contributions of four dimensions of emotional intelligence and perceived organisational support in work stress of nurses in a teaching hospital in Nigeria.

Methods

The study was a cross-sectional survey research design, which selected 228 (41 male and 187 female nurses) nurses through the use of convenience sampling. Questionnaires comprising demographics with work stress, organisational support and emotional intelligence scales were administered to the sampled 228 nurses in the study. Data were analysed with the use of correlational matrix and hierarchical multiple regression.

Results

Self-emotion appraisal, others’ emotion appraisal, use of emotion, regulation of emotion and perceived organisational support were found to have joint contributions to explaining work stress among nurses. Others’ emotion appraisal, use of emotion and perceived organisational support were found to have independent relationships with work stress.

Conclusion

Our findings stress that judgement of others’ emotions, accurate use of emotion by nurses and support from management of the hospital are most important in explaining their reactions towards work-related stress.

Medical managers' managerial self-efficacy and role clarity: How do they bridge the budgetary participation-performance link?

This study explains the process ''how'' organizational accounting practices, such as budgetary participation, influence medical doctors' perceptions and beliefs associated with their hybrid role and what the consequences are on their performance. Building on social cognitive theory, we hypothesize a structural model in which managerial self-efficacy and role clarity mediate the effects of budgetary participation on performance. The data were collected by a survey conducted in an Italian hospital. The research hypotheses were tested employing a path model. The results suggest that role clarity and managerial self-efficacy fully mediate the link between budgetary participation and performance. From a managerial viewpoint results suggest that organizations that invest in budgetary participation will also affect individual beliefs about the perceived benefits of participation itself, since an information-rich internal environment allows employees to experience a clearer sense of direction through organizational goals. According to our results, organizations that seek self-directed employees should pay attention to the experience the medical managers acquire through budgetary participation. In fact, this event influences the employees' mental states-and specifically provides them with information needed to perform in the role and enhance their judgment of their own capabilities to organize and execute the required course of actions-which take on internal psychological motivation to reach performance levels.

A Systematic Review of the Effects of Stress and Coping Strategies Used by Occupational Therapists Working in Mental Health Settings

A systematic review of the research literature published in the United Kingdom between 1966 and 2000 was carried out to determine the effectiveness of stress management interventions for occupational therapists working in mental health settings. Studies from other countries were examined as potential models of good practice. The review was limited to primary research papers that involved occupational therapists working in the mental health arenas, where the health outcomes measured were stressors, moderators and stress outcomes and where sufficient data were provided.

The initial search identified 30 papers, of which 13 met the inclusion criteria. One study has been reported since the completion of the review and has been included in this article. All the papers focused on the stressors, moderators and stress outcomes. There was no paper that specifically investigated the effectiveness of stress management interventions for occupational therapists working in the mental health arena. The only literature available was aimed at the occupational therapy profession as a whole and was in the form of a number of recommendations at an organisational and an individual level. Methodological flaws, however, detracted from the rigour of many of the studies.

The review demonstrated that a great deal is known about the sources of stress at work, about how to measure stress and about the impact of stress on a range of outcome indicators. What was found to be lacking was a translation of these results either into practice or into research that assessed the impact of interventions that attempted to moderate, minimise or eliminate some of these stressors.

Effective communication in mental health nurses: Did social support save the psychiatric nurse?

A randomised controlled trial was conducted to test the effectiveness of a social support-based intervention against a feedback-only condition. Fifty-three mental health nurses were randomly allocated and assessed on a range of measures of the stress process. Stressors were measured by the DCL Stress scale, mediating variables by the Rosenberg Self-Esteem scale, the Pearlin Mastery scale and the Significant Others scale and stress outcomes by the General Health Questionnaire and the Maslach Burnout Inventory. Following a successful pilot of the social support package, it was hypothesised that the social support intervention would be more effective in reducing stress and burnout in mental health nurses. Participants in both groups were assessed prior to randomisation, post-treatment and at six months follow-up. Attrition rates were similar in both conditions, at around 30%. The social support groups were run for five consecutive weeks for two hours. In all, three separate groups were conducted by two facilitators. The members of the feedback-only group received detailed written feedback on their stress questionnaires, as well as a small stress management booklet developed by two of the authors. Results of the study show no benefits for participants of the social support groups on the study's dependent variables and indeed there was a trend for the feedback-only group to do slightly better on some of the measures. The reasons for this negative outcome are discussed and suggestions are made for future studies. Methodological difficulties are pointed out with studies that attempt to reduce staff stress.

Employee Burnout: A Meta-Analysis of the Relationship Between Age or Years of Experience

This study examined the relationship between age or years of experience and employee burnout by performing a meta-analysis on research studies that present findings on relationships between employee burnout and age or years of experience. The problem has practical significance in that the appropriateness of approaches to addressing employee burnout may depend on whether age or years of experience is a factor related to burnout. Results indicated that there was a small negative correlation between employee age and emotional exhaustion, one of the components of burnout, at least for employees in some fields in the United States, and possibly a small negative correlation between years of experience in a field and emotional exhaustion.

Recommendations for enhancing psychosocial support of NICU parents through staff education and support

Providing psychosocial support to parents whose infants are hospitalized in the neonatal intensive care unit (NICU) can improve parents' functioning as well as their relationships with their babies. Yet, few NICUs offer staff education that teaches optimal methods of communication with parents in distress. Limited staff education in how to best provide psychosocial support to families is one factor that may render those who work in the NICU at risk for burnout, compassion fatigue and secondary traumatic stress syndrome. Staff who develop burnout may have further reduced ability to provide effective support to parents and babies. Recommendations for providing NICU staff with education and support are discussed. The goal is to deliver care that exemplifies the belief that providing psychosocial care and support to the family is equal in importance to providing medical care and developmental support to the baby.

Obsessive Passion as an Explanation for Burnout: An Alternative Theoretical Perspective Applied to Humanitarian Work

Burnout is an occupationally based syndrome that develops as a result of prolonged and cumulative stress. The experience of burnout has been documented in detail in a variety of human service professions. The purpose of this article is two-fold: to provide an alternative theoretical perspective on the development of burnout, which suggests it is not stressors per se that are responsible for burnout development; and, to use this alternative perspective as an explanation for burnout in the context of another human service profession — humanitarian work. Using the passion for activities notion conceptualised by Vallerand and colleagues (2003), it is explained how a lack of self-determination and autonomy leads to the development of an obsessive passion for an activity. Obsessive passion is linked to a variety of adverse cognitive and affective outcomes. This is then applied to the domain of humanitarian work, and it is suggested individuals with an obsessive passion are more likely to suffer adverse outcomes and consequently develop burnout when working in humanitarian crises. Some suggestions for future theoretical and empirical investigations regarding the relationship between obsessive passion and burnout are provided.

Staff Burnout--a Comparative Study of Metropolitan and Rural Mental Health Nurses within Australia

This article will present the findings of a research study that investigated the extent to which mental health nurses employed within rural and metropolitan areas of Australia are affected by burnout, using the Maslach Burnout Inventory (MBI) and a demographic questionnaire. The study also examined whether the Maslach Burnout Inventory (MBI) was a valid measure of mental health burnout within the Australian context and culture or alternatively, in what ways it needed to be refined? A cross-sectional study of mental health nurses (n  =  319) from the states of New South Wales, Victoria, Queensland and Western Australia was undertaken. The 22-item Maslach Burnout Inventory (MBI) was used to measure burnout and a demographic questionnaire utilising a cluster sampling, cross-sectional design survey method, was used to gather the data. The study found that gender and level of qualification were the two major factors that showed any significance, where males experienced a higher level of depersonalisation on the frequency and intensity sub-scale scores of the MBI and that the more qualified a nurse, the greater the level of depersonalisation they experienced. These results were true for participants in both rural and metropolitan settings within Australia. Age was the third most influencing factor in terms of emotional exhaustion, where younger participants (under 30) reported higher levels of emotional exhaustion. Younger male mental health nurses experienced higher levels of depersonalisation.

Work stress and emotional exhaustion in nurses: the mediating role of internal locus of control

BACKGROUND

Burnout is a major problem for nursing. There is a strong relationship between work stress and emotional exhaustion. Although studies report a negative correlation between the internal locus of control and emotional exhaustion and work stress, the number of studies available on the subject is limited.

PURPOSE

This study intends to examine the extent to which the relationship between work stress and emotional exhaustion is mediated by nurses' internal locus of control.

METHODS

The study adopted a cross-sectional survey design. The data were analyzed using structural equation modeling techniques. The study sample consisted of 347 nurses who worked in a university hospital in Izmir, Turkey and who agreed to participate in the study. The Work-Related Strain Inventory was used to evaluate the nurses' work stress level, Maslach Burnout Inventory was used to evaluate their emotional exhaustion levels, and the Locus of Control Scale was used to evaluate the internal locus of control. The variables of the study were based on the Neuman Systems Model.

RESULTS

Work stress was positively related to internal locus of control (β3 = .21, p < .001), which was, in turn, negatively associated with emotional exhaustion (β = -.03, p > 0.1). Internal locus of control was negatively related to emotional exhaustion (β = -.14, p < .001). Work stress is directly (β = .87, p < .001) and indirectly related to emotional exhaustion (mediated by internal locus of control β = .84, p < .001). Work stress is directly (β = .87, p < .001) and indirectly related to emotional exhaustion (mediated by internal locus of control, β = .84, p < .001).

CONCLUSION

Although the relationship between emotional exhaustion and work stress was mediated, the impact of internal locus of control was limited. It is recommended that different variables be included in future studies so that they can mediate the relationship between work stress and emotional exhaustion.

Occupational stressors, burnout and coping strategies between hospital and community psychiatric nurses in a Dublin region

Burnout negatively impacts the delivery of mental health services. Psychiatric nurses face stressors that are distinct from other nursing specialities. The research was conducted in Ireland and captured a relatively large sample of respondents. The results compared the stressors, coping strategies and burnout levels between hospital and community-based psychiatric nurses. Occupational stress can negatively impact on the well-being of psychiatric nurses, which in turn can lead to poor client care. There is a dearth of published research conducted in Ireland that examines stress within the discipline. A between-groups study, undertaken in February 2011, investigated stressors, burnout and coping strategies between hospital and community-based psychiatric nurses in a Dublin region. Sixty-nine participants (8 males and 61 females), aged between 18 to 60 years voluntarily completed the Mental Health Professional Stress Scale, the Maslach Burnout Inventory and the PsychNurse Methods of Coping Scale. The findings revealed that nurses were operating in a moderately stressful environment. Stressors focused on organizational issues as opposed to client issues. The main stressors identified were lack of resources, workload and organizational structures/processes. Both groups reported average levels of emotional exhaustion, low levels of depersonalization and average levels of personal accomplishment. A Mann-Whitney U-test and Independent Samples t-test found significant differences between hospital and community-based nurses regarding depersonalization and personal accomplishment, respectively. Hospital nurses reported higher depersonalization scores, and community nurses had a greater sense of personal accomplishment. The personal accomplishment scores of hospital nurses were below mental health professional norms. No significant differences emerged regarding coping strategies. Avoidant coping strategies were favoured by both groups. It is recommended that interventions aimed at increasing personal accomplishment be implemented for both groups of nurses. An investigation of perceived job control and the use of social support would also be insightful.

Work-related Mental Consequences: Implications of Burnout on Mental Health Status Among Health Care Providers

INTRODUCTION

Burnout can create problems in every aspect of individual's' human life. It may have an adverse effect on interpersonal and family relations and can lead to a general negative attitude towards life.

AIM

The purpose of this study is to investigate whether burnout is associated with the mental health status of health care providers.

MATERIAL AND METHODS

The sample in this study consisted of 240 health care employees. The Greek version of Maslach's Burnout Inventory (MBI) was used for measuring burnout levels and the Greek version of the Symptoms Rating Scale for Depression and Anxiety (SRSDA) questionnaire was used to evaluate health care providers' mental health status. Descriptive statistics were initially generated for sample characteristics. Normality was checked by the Kolmogorov-Smirnov test and data was processed with parametric tests. General linear models with MBI dimensions as independent variables and SRSDA subscales as dependent variables were used to determine the relation between burnout and mental health status. Statistics were processed with SPSS v. 17.0 (SPSS, Chicago, IL, USA). Statistical significance was set at p=0.05.

RESULTS

The average age of the sample is 40.00±7.95 years. Regarding gender the percentage of men is 21.40% (N=49) and of women is 78.60% (N=180). Overall the professional burnout of health care workers is moderate. The mean score for emotional exhaustion is 26.41, for personal accomplishment 36.70 and for depersonalization 9.81. The mean for each subscale of SRSDA is 8.23±6.79 for Depression Beck-21, 3.96±4.26 for Depression Beck-13, 4.91±4.44 for Melancholia, 6.32±4.35 for Asthenia and 6.36±4.72 for Anxiety. The results of general linear models with the MBI dimensions as independent variables and the SRSDA subscales as dependent variables are shown that emotional exhaustion and personal accomplishment are statistically correlated with all subscales of SRSDA, while depersonalization is not correlated with any SRSDA subscale.

CONCLUSIONS

Burnout appears to implicate mental health status of healthcare providers in work index. Emotional exhaustion is the burnout dimension that is correlated the most with employees' mental health.

Relationships among structural empowerment, psychological empowerment, intent to stay and burnout in nursing field in mainland China-based on a cross-sectional questionnaire research

The aim of the study was to explore the relationship among perceived structural empowerment, psychological empowerment, burnout and intent to stay by nurses in mainland China.With the shortage of nurses in many countries, including China, intent to stay is a dominant factor to influence the quality of care. Also, burnout is identified to negatively affect the quality of care. Empowered clinical nurse practical environment is related to intent to stay and burnout. In the current literature, there is a lack of data based on empowering environment discussing the relationship between burnout and intent to stay. The study used an anonymous questionnaire, filled voluntarily by 219 nurses from different sections in a city in mainland China, 2012.Structural equation modelling (SEM) was used to test the proposed hypotheses. Based on the SEM model, structural empowerment and psychological empowerment had significant positive effects on intent to stay of nurses and negative effects on burnout. Burnout had a significant negative effect on intent to stay. The final modified models yielded χ(2)  = 58.580, P > 0.05, χ(2) /df = 1.046, root mean square error of approximation = 0.015, Tucker-Lewis Index = 0.996, comparative fit index = 0.998,which indicated good fit indices. Creating a positive empowering workplace can encourage nurses to stay long and prevent burnout. Therefore, higher level of empowering environment is required.

The Role of Self-Esteem and Self-Efficacy in Moderating the Effect of Workplace Stress on Depression, Anxiety and Stress

Seventy-eight employees (32 males, 46 females) took part in a study to test the hypothesis that the core self-evaluation components of self-esteem and self-efficacy moderate the relationship between workplace stressors (role conflict and role-ambiguity) and strain (depression, anxiety, and tension-stress). Results supported our hypotheses in that self-efficacy moderated the relationship between role ambiguity and depression and between performance role ambiguity and stress, while self-esteem moderated the relationship between role ambiguity and anxiety, between performance role ambiguity and anxiety, and between performance role ambiguity and stress. These findings reinforce the importance of considering role stress variables in relation to the context of an interactive person/environment fit model and provide further insight into the nature of the stress process itself. Furthermore, these results indicate that the function of self-esteem and self-efficacy in the stress process is not identical. Implications for the conceptualisation of the transactional model of stress are discussed.

The consequences of nursing stress and need for integrated solutions

PURPOSE

In a 2011 survey sponsored by the American Nurses Association (ANA), nurses identified the acute and chronic effects of stress and overwork as one of their two top safety and health concerns.

DESIGN/METHODS

A review of the literature was conducted to investigate the impact that job stress has on the health and safety of nursing professionals and the role that working conditions and job characteristics play in fostering job stress.

FINDINGS

Strong evidence supporting links between job stress, safety and health in general and within different types of nursing populations exists. Working conditions also contribute to the development of job stress.

CONCLUSION

Combining and integrating "person-focused" strategies designed to build nurses' ability to manage stress at the individual level with "organization-focused" strategies that eliminate stressful working conditions is critical to the reduction and prevention of job stress among nursing professionals.

Self-Esteem, Job Satisfaction and Burnout between General and Psychiatric Nursing Staff

The purpose of this study was to compare self-esteem, job-satisfaction and burnout between psychiatric and general nurses as well as to determine how these three elements are interrelated to each other. Like other professionals, nurses are also at risk of developing problems like professional burnout and a sense of dissatisfaction regarding their jobs. Causal factors of burnout among professionals are multi-factorial, starting from socio-demographic and occupational background to one’s personality characteristics. In this study, 30 psychiatric nurses and 30 general nurses were selected through a purposive sampling method. This was a one-time cross-sectional hospital-based study, data was collected during the period September, 2008 to November, 2008 and written consent was taken from the subjects. Statistical measures like descriptive statistics, Chi-square test, t-test and Pearson’s correlation-coefficient were used to analyze the data. In this study psychiatric nurses had been found to have higher level of self-esteem than general nurses. Nurses working in a general hospital had been observed to have a higher level of burnout and lower job satisfaction than psychiatric nurses.

Coping with interpersonal stress and psychological distress at work: comparison of hospital nursing staff and salespeople

Hospital nurses frequently experience relationships with patients as stressors in the workplace. Nurses’ coping behavior is one potential buffering factor that can reduce the effects of job stress on their psychological functioning and well-being. In this study, the association between nurses’ strategies for coping with interpersonal stress from patients and their psychological distress was examined. Participants included 204 hospital nurses and 142 salespeople, who were used as a comparison group. Participants completed measures of coping with interpersonal stress and psychological distress. Hospital nurses reported more psychological distress than did salespeople. Moreover, distancing coping was correlated with high psychological distress in both nurses and salespeople, and reassessing coping was correlated with low psychological distress in nurses. For nurses only, constructive coping appeared to be an effective strategy for reducing psychological distress. It is important for nurses to understand the role of constructive coping in nurse–patient communication and interaction.

Case studies of patient interactions, care provision and the impact of emotions: a qualitative study

Caring is a complex phenomenon. Nurses aim to relieve patient suffering, acknowledge subjective experiences, display empathy but also manage emotions related to care provision. This study explored nurses' perceptions, experiences and emotions related to caring for cancer patients. This qualitative study used semi-structured interviews to explore the emotions management of 32 nurses working in a cancer hospital in Pakistan. Data saturation occurred after 20 interviews. Three themes emerged from the data related to caring, acknowledgement of patients' feelings, professional behaviour, patient involvement and emotional control. Some nurses repressed their emotions and feelings over patients who had difficulties sustaining hope. In such cases nurses require supportive networks to assist their emotions management and intra-personal skills. Educational support is needed to help nurses express their views in relation to emotional contagion, significance of repressed emotions and to identify supportive ways to assist nurses to communicate their experiences.